Nihira Mikio A, Drake Natalie L, Corton Marlene M, Wai Clifford Y, Coleman Robert L, Quiroz Lieschen H
Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
Female Pelvic Med Reconstr Surg. 2012 Mar-Apr;18(2):97-102. doi: 10.1097/SPV.0b013e318247500f.
Although gynecologists perform a large number of surgeries in close proximity to the ureters and the urinary bladder, traditionally, Obstetrics and Gynecology resident physicians are not formally taught to perform cystoscopy. The primary objective was to document resident physicians' performance in diagnostic cystoscopic instrumentation and technique. The secondary objective was to examine if reported prior cystoscopic experience was associated with superior performance.
Fifty-one postgraduate year 4 residents with reported experience with cystoscopy were evaluated using an operation-specific checklist and a global ratings scale based on the Objective Structured Assessment of Technical Skill model. Before evaluation, they attended a formal training session in cystoscopy, which included practice on a bench model of a simulated bladder.
Forty-three of the 51 residents were able to successfully perform a thorough diagnostic examination immediately after the course. Six of the 8 failures were re-evaluated 2 weeks later and successfully performed a complete examination at that time. Before the course, the residents had performed a mean of 12.2 cystoscopic examinations as the primary surgeon (median, 12; range, 2-33). The number of reported cystoscopic examinations performed before the course did not correlate with the ability to perform a thorough cystoscopic examination (r = -0.109; P = 0.496).
For this group of residents, there was poor correlation between the number of reported cystoscopic examinations and the ability to perform diagnostic cystoscopy. Trainees may not be able to determine when they have received enough instruction in hands-on training with models before acquisition of technical skills.
尽管妇科医生在输尿管和膀胱附近进行大量手术，但传统上，妇产科住院医师并未接受正式的膀胱镜检查培训。主要目的是记录住院医师在诊断性膀胱镜检查仪器操作和技术方面的表现。次要目的是检查报告的既往膀胱镜检查经验是否与更好的表现相关。
使用基于客观结构化技术技能评估模型的特定手术检查表和整体评分量表，对51名报告有膀胱镜检查经验的四年级住院医师进行评估。在评估前，他们参加了一次膀胱镜检查的正式培训课程，其中包括在模拟膀胱的实验台上进行练习。
51名住院医师中有43名在课程结束后能够立即成功进行全面的诊断检查。8名未成功的住院医师中有6名在2周后重新接受评估，并在那时成功完成了完整的检查。在课程开始前，住院医师作为主刀医生平均进行了12.2次膀胱镜检查（中位数为12次；范围为2 - 33次）。课程开始前报告的膀胱镜检查次数与进行全面膀胱镜检查的能力无关（r = -0.109；P = 0.496）。
对于这组住院医师，报告的膀胱镜检查次数与进行诊断性膀胱镜检查的能力之间相关性较差。在获得技术技能之前，学员可能无法确定他们在使用模型进行实践培训时何时已接受了足够的指导。
